The symptoms are normal with serious examination, and there may be psycho-emotional problems.1 Some patients have symptoms of panic, chest pain, chest tightness, etc. However, various examinations of the heart were done but no problems were found. What is going on here? In clinical practice, we call heart panic, chest tightness, etc. as non-specific symptoms, sometimes accompanied by dizziness, headache, weakness, and not wanting to eat. If these problems are persistent, or if they occur in one episode but the symptoms are very pronounced, the first thing to consider is whether there is organic heart disease. If none of the relevant tests are problematic, that is, if the patient’s subjective symptoms do not quite match the objective findings, we consider whether the patient has functional heart disease, such as certain heart problems caused by psycho-emotional issues. In the past, we diagnosed this condition as cardiac neuropathy because it was mainly related to neuromodulation. However, as research has progressed, cardiac neurosis no longer encompasses all of the categories of functional heart disease. As a result, the condition is now referred to as psychological heart disease, or bicardiac disease. Bipolar heart disease is related to heart disease in 3 ways.2 What is the relationship between psychological heart disease and what is commonly referred to as heart disease in the general population? Does it exist independently, or does it occur at the same time as heart disease? The relationship between psychological heart disease and heart disease is roughly divided into 3 cases. First, psychological heart disease can exist independently. In other words, the patient does not have a real heart attack, but mainly mental, emotional and spiritual problems cause symptoms similar to heart disease, and once the patient has an attack, it is like a heart attack. Secondly, psychological heart disease exists in combination with heart disease. Due to personality, genetic or environmental reasons, the patient is under very strong bad emotions and mental stress. Gradually, his heart becomes damaged and organic heart disease, such as coronary heart disease and arrhythmia, occurs. This type of patient needs treatment for heart disease, but at the same time, he also has psychological problems. In general, such patients tend to have psychological problems in the first place and heart problems in the second. In the third case, the heart disease, as a stressful blow, causes psychological changes in the patient. For example, there are many patients with coronary artery disease who feel uncomfortable after stenting or bypass surgery, although the revascularization is successful and the ECG results suggest good blood supply to the heart. The patient will say, “After the surgery, the doctors said it was fine, but for some reason, I felt the symptoms were getting worse.” This is often a case of heart disease first and then a psychological problem. In short, there is a very close relationship between psychological problems and heart disease, both in terms of symptoms and diagnosis. Therefore, it is often named after bipolar heart disease. Psychological and emotional problems can also cause ischemia of the heart and produce symptoms similar to heart disease.3 Why do psychological and emotional problems cause symptoms of the heart? What is the approximate mechanism? There is indeed an inextricable link between psychological and emotional problems and heart disease, and there is a very complex pathophysiological mechanism behind it. Simply put, when a person is anxious and anxious, the excitability of the nervous system increases and the body releases many neurotransmitters, such as adrenaline and norepinephrine. These neurotransmitters will make the blood vessels constrict, and the corresponding local tissues of the heart may be ischemic or have certain reactions, thus causing some symptoms similar to heart disease.4. Why do many patients have heart tests and can’t find any problems? For heart problems caused by anxiety and stress, it is really difficult to check if it is not at the time of onset. Usually, for patients with heart disease symptoms, we first perform some routine screening tests, such as electrocardiogram, ultrasound, and imaging, to find out whether there are organic problems in the heart. In addition, we also perform appropriate stress measurements, such as mood scales, to reflect whether the patient has emotional and psychological problems and whether these problems are associated with corresponding myocardial ischemic events.